help to understand need of sleep in old age person

1. SCOPE OF SAMYAKA NIDRA IN GERIATRIC
HEALTH
SCHOLAR
DR. PRRETI SENTHIYA
M.D. FINAL YEAR
( SWASTHAVRIITA)
PT. KHUSHILAL SHARMA GOVT. AYURVRDA COLLEGE & HOSPITAL BHOPAL (M.P.)

2. ❖ Introduction-
Sleep is very important physiological phenomenon, which
accounts 1/3rd of human life. It restores body and mind.
Sleep complaints are common in all ages, but their
prevalence increases with age. Over 40% of elders will
report subjective sleep complaints, many of whom may be
diagnosable with insomnia. Sleep problems are common
with aging and occur in over 50% of adults aged 65 and
older.

3. WHO-ICD defines insomnia as “a condition of unsatisfactory
quantity and/or quality of sleep, which persists for a
considerable period of time, including di culty falling asleep,
di culty staying asleep, or early final wakening.
Geriatric insomnia is quite di erent from insomnia found in
person before 60 years.

4. ACHARYA CHARAKA
considered jeernavastha stage of man after sixty year of age and
said in this age naturally the strength of body, dhatu and indriya
depleted, the qualities of dhatus also gets deteriorated
(bhrashyamandhatuguna) and Vata dosha become predominant
(C.Vi.8/122).

5. Acharya Chakrapani said old age (kala) itself is a causative
factor for insomnia and naturally the old persons are tend to get
less sleep (Kala iti vardhakya, vriddha hi swabhavatha eva
jagaruka bhavani) (C.Su.21/57).
Acharya Vagbhata and Shusruta -indicating that in old age Vata
dosha is found in predominance (A.S.Su.1/25).

6. CAUSES - Number of factors can cause insomnia in geriatric person
✔ social
✔ psychosocial problems
✔ increasing prevalence of concurrent medical
✔ psychiatric, and neurologic illnesses
✔ increasing use of medications (often sedative-hypnotics)
✔ Alcohol
✔ alterations in circadian rhythms.

7. NIDANA OF NIDRANASHA IN GERIATRICS:
Acharya Charaka explained that Karya (continuous indulgence
in work), Kala (old age), Vikara (Vata disease according to
Chakrapani), Prakriti (Vata prakrati) and Vata (aggravated)
considered as causative of insomnia (C.Su.21/57).

8. ❖ Nidranasha/Anidra is not explained as a separate
disease in Ayurveda, thus its Samprapti is not
available in Ayurvedic classics or other text.
Depending upon the dosha, dushya involvement
Nidranasha /Anidra could be emphasized.
Nidranasha/Anidra is mentioned as Vataja Vikara
along with Pitta vriddhi (S.Su.4/41) associated with
some other disease states or symptoms which is
common in aged people.

9. ✔ But more than that, in the old age, dhatu kshaya plays a
vital role in pathogenesis.

10. In Geriatric men the sudden change in life style, social-
environmental influence causes stress, depression and
anxiety are quiet common; which ultimately disturbs the
psycho neuro-biological rhythm of sleep and causes
insomnia.
Number of observational studies indicating that, the poor
quality of sleep and insomnia are directly related with
emotions, loneliness, grief, hostility, impulsivity, stress,
depression, and anxiety. Ayurvedic classics also opine the
same (C.Su.21/55-57) (S.S.Sha.4/41) (A.S.Su.9/53, 54).

11. All these causative factors vitiate the Vata & Pitta dosha and
simultaneously do Rajo vriddhi (vitiate Manasika Dosha).

12. In modern medicine, various sedative drugs are being used but
till now no e ective management for Geriatric Insomnia is
found. Geriatric insomnia is developed because of the old age
naturally; the dhatu kshaya and loss in indriya functions occurs
which in turn cause aggravation of Vata dosha. Thus the
selection of the treatment procedure as well as drug, which
could nourish the dhatu and pacify the aggravated Vata dosha
is needed to treat geriatric insomnia.

13. NIDRANASHA BHEDA:
Nidranasha can be classified under the following two broad
headings by considering its etiological factors:
1.Swatantra Nidranasha – where Nidranasha is an independent
disease.
2. Paratantra Nidranasha – where Nidranasha appears as a nidana,
lakshana, poorvarupa, upadrava or asadhya lakshanas of some
diseases.

14. SWATANTRA NIDRANASHA
Charaka Samhita, Ashtanga Samgraha etc have mentioned Nidranasha as a
disease condition under Nanatmaja Vatavyadhi and Pitta Vriddhi Lakshanas.
Shusruta Samhita has given the causative factors of Nidranasha as vitiated
Vata and Pitta but it has not been described as a separate disease.

15. PARATANTRA NIDRANASHA
Nidranasha is also present in numerous diseases as a part of
nidana, lakshana, purvarupa, upadrava and asadhya lakshanas.

16. CHIKITSA: (C.SU.21/52-54)
BAHYA UPACHARAS FOR NIDRANASHA
Charaka mentioned Abhyanga, Utsadana, Samvahana, Akshitarpana, Shiro Lepa,
Karna Purana, Shiro Basti, Shirodhara and Moordhni Taila as bahya upacharas.
MANASIKA UPACHARAS FOR NIDRANASHA
Charaka mentioned Manonukula vishaya grahana, Manonukula sabda granaha,
Manonukula gandha granaha, as manasika upacharas.

17. AAHARA UPACHARAS FOR NIDRANASHA
Charaka mentioned Gramya mamsa rasa, Anupa mamsa
rasa, Jaleeya mamsa rasa,Ksheera, Dadhi, Ghrita and
Madhya as Aahara upacharas.
AUSHADH CHIKITSA
Various aushadha mentioned in the classics like – Brahmi, Aswagandha,
Bhanga,
Shankapuspi, Jatamamsi, Katu Tumbi, Jatiphala, Apamarga Moola, Khas
Khas,
Kupilu, Tagara, Raja Sarshapa, Kusmanda, Yamini, Pippali Moola,
Sarpagandha,
Punarnava, Karpura, Parasika Yavani etc. can be used.

18. CON CLUSION
Geriatric Insomnia is a Dhatu Kshayaja and Vata predominant
disease in elderly.
✔ Main aim of Chikitsa is to correct the imbalance doshas, vitiated srotas and malas.
✔ Chikitsa means not only removal of nidanas, but also maintaining of doshik equilibrium. (C.
Su.9/4)
✔ Concept of Ayurveda to treat the Nidranasha is basically – (C.Su.21/52-54) First, it should
treat the Dhatu kshaya by doing Brimhana especially at the Murdha level in Geriatric
Insomnia.
✔ Correct the vitiation of Vata and Pitta dosha or pacifying Vata and Pittam dosha.
✔ Make balance in the Mansika dosha of raja.

19. THANK YOU